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HomeMy WebLinkAboutBSHD-26-9 application 1-41k f S 6x i Office Use Only FEB 1 '1 2026 Permit#bst(0-aG-ci •our�wcw�cs/sc/ Lr Amount 3- Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 33 Seminole Drive, Yarmouthport, MA 02675 OWNER: Rita and Michael Seraderian 617-593-8097 NAME PRESENT ADDRESS TEL. # CONTRACTOR: Pine Harbor. 259 Queen Anne Road. Harwich MA 02645 508-430-2800 NAME MAILING ADDRESS TEL.# EMAIL: rsmooge@gmail.com ©Residential 0 Commercial 1 Est.Cost of Construction$8000 Home Improvement Contractor Lic.# 132935 Construction Supervisor Lic. James R. McGrath SHED INFORMATION New X Size L 12'4) x w 10'-0" x g 11'-7" Corner Lot:Yes No X Per Town of Yarmouth Zonine By-Law Sec 203.5 Note E: side and rear yard setbacks for accessory buildings containing one hundred fifty (150) square jimt or less and single story, shall be six (6)feet in all districts, hut in no case shall said accessory buildings he built closer than threlve (12)fe et to any other building on an adjacent parcel. All sheds are required to he located thirty (30)feet from any front lot line Replace existing* Size L x W x H *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that the is herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial ocati f my livens and for prosecution under IVLG.L.Ch.268,Section I. Applicant's Signature: , Date: 1 t/`O Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Zoning District: Historical District:>l Yes ❑ No **Conservation review will be required if shed is placed within 100ft of wetland,20011 from riverfront,or located within a flood zone** 6/24 The Commonwealth of Massachusetts -'- -_ 1, 'i Department oflndrrsstrialAccideuts _ =,n- 1 Congress Street Suite 100 r=';:_ Boston,MA 02114-2017 wwwgov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractore/Eleetrldaaa/Plambers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aunt Information , 1 \4 ►e9c� LL C Legibly Name 'vidl):Y i1 tm arbor Address: 2-S 9 C i sn tC'`I' re.' cityistaterzipi+o ww t A\IN Y114 OZihs Phone#: 5"oa ' tt3 © —t S C`Xti An as employer?Cheer the appropriate nu: Type of Project(required): t. [em a employer with employees(full and/or pram-time)• 7.' New construction 20 t am a sale proprietor or partnership and have as employees working for nil.; : „ 8. Remodeling any capacity.[No workers'comp.insurance required.) t r 9..El Demolition 31:1 1 an a homeowner doing all v►ort myself(No workers'comp.insurance required]t &O t am a homeowner and will be hiring conlracsots toconduct all work onr y property. 1 will 10 0 Building addition ensure tint all COCall ltna either have workers'campatsation insurance car are sole 11.0 Electrical repairs or additions proprietors with se employees. 12.0 Plumbing repairs or additions 54:1 I am a ge a al contractor and 1 have hired the sub-contractors hexed an the attached sheet 13.0Roof repairs These subcontractors have employees end have wadies'comp.insurance.: 4.0 We me a co/potation and its officers have exercised their right of exemption per MGL c. 14.pother 152,11(4).and we bave no employees.(No fin'comp.insurance requited.] •Any applicant that cbedo box M1 mint also ,.out the section below showing their workers'compensation policy information t 1lomeowsera who submit this affidavit indicating they are doing all work and then hue outside contractors east submit a new affidavit indicating such. :Contractors that check this box must attached at additional sheet showing the name of the sub.coctracmn and state whether or not those entities have employees. If the sub-cootraceors have employees.they most provide their workers'comp.policy number. I am an employer that tt providing workers'compensation insurance for any employees. Below Is the policy andJob site information. w Insurance Company Name: e a'la _ " l' 1 _ 1I* t; i5 di • • w . ' ►► : Vtll.E.1 Policy 0 or Self-ins.tic.#:a,CC'-pod •w 12 4 9�-202S Expiration Date:2 j2$ 1'26 Job Site Address: City/Stale/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fun up to$1,500.00 and/or one-year imprisonment,as welt as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this ens forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby cen 4measifpeviurY that the information provided above it Ume and comet signature: Date: 5//0/l: Phones: CQ 'e (-(3 b —li n Official use only, Do not write In this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: c Y ��re et ��4., aeeac, e • Office of Consumer Affairs and B uginess-Regulation .% r ; „ 10 Park N aaa•- Suite 5170 tz_fi . Boston, -"etts 02116 . - m ' 'Hom Iprovement � • Registratiom . . • • Commonwealth of Massachusetts .• . • . II '� f ' ' ;at Division of Occupational onal Licensure • 1i�t�CRATH POST BEAM CO. �` �, r.— a..� JAMES McGRATH - :` - 44'- 4 . 259 C)UEEN ANNE RD. .. '_w o3J1412o2ti JAMES R MiOR ; HAR1AlICH,1GIA lQ264'S i T -: ^. 204 CRAPIV F a ! BREWSTER 026-3; •r ,. OMf' ; m eetaneaee�entesw - ���Ud3 i(.til��� Conirn ssioner xydz. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affarre and Business Regulation 1000 Washington Strut-Suite 710 Bostonryassechusj:02118 Home Improvem" • actor:Registration ,+ `. �y'F .7, i "f .:a, :t Type: Corporation 32935 MCGRATH POST&BEAM CORPORATION 4,_, > 3 "" '# : 1D�0/2028 DIB/A PINE HARBOR WOOD PROD. '`( 259 QUEEN ANNE RD. 5`" r�. —�--= ' HARWICH,MA 02845 3 '.•. i. ._.._ Update Address end Realm Card. THE COMMONWEALTH OF MASSACHUSETTS ORlos of Consumer Affair%S Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date.U found ream to: TYPE:Coipofadon OIRee of Consumer . , Regulation 'co Siiittlim W _.,i, Boston,MA , MCGRATH POST S BEAM CORPORATION 0B/A PINE HARBOR WOODPROD. _. - ILDAMES R.MCGRATH ', . 259 QUEEN ANNE RD. •-.. f V-*„aIA HARWICH.MA 02645 ,. .` Undersecretary 7 „is aZ o ti 0o O Q N cs to 1 i v)e o \ a fl tb 1.4 Al C .N Si UO Q O a +.• t7 1 I � 'FOB °s ne N::-: '. -' 4 g $ I� 2 h l g OcaiO \ \ § p2 j �' b x Z 1 t< 4.1 4. ', gy m ' L. Q U `n `O N g� a e W h o 81 j x eta' n1 „ W a ., N -i a ,6 e u �: ¢f W W W W M _ 1 3. o yj ISE::: Ord w F. N wy R '. ev tF / gi i o kiZ ° '•; O 8 6"" �4, "a' $ s4. . c N Q�.l. o n NN. , „ rye/:;. bi..t,a \. a/ ..), ,„. 4, , . / g§ . °, / ®ems s.W s 8 q. dbr` \,,,, rye• /'1 - )D / s 44 q. // fa \ /gip s i 9/ N /LbN ./ 3 //--�� w e PLAN BK. 336-53 /i l�� j (S CO m 4. pp b i 4